O n December 7, 1988, an earthquake with a magnitude of 6.9 on the Richter scale struck Armenia (population 3.5 million). It caused the destruction of four cities and 350 villages and killed at least 25,000 people in a region populated by approximately 550,000 people. The second largest city of Armenia, Gumri, was 20 miles from the epicenter. At least 18,000 people (7% of the city's total population) were killed in this city. Approximately 50% of the buildings in Gumri were destroyed. The earthquake occurred late in the morning when children and adolescents were in school. Nearly all of the children experienced extreme direct threats to their life and were exposed to horrifying sights and sounds during the earthquake and for several days thereafter.The literature indicates that there can be serious and long-lasting psychiatric consequences among children and adolescents after natural and man-made disasters (1-3). Our previous studies in Armenia have documented severe posttraumatic reactions and high rates of comorbid depression 1 1 ⁄2 years after the earthquake among children and adolescents in cities that were close to the epicenter (4, 5). The severity of their symptoms was attributable to extreme disaster-related experiences during, and in the aftermath of, the earthquake. Such findings indicate the need for provision of mental health services.To date, there is a paucity of controlled treatment outcome studies in children or adolescents after disasters (6, 7). After the 1980 earthquake in Italy, Galante and Foa used monthly structured classroom interventions over 1 academic year and reported a reduction in earthquake-related fears (8). This study did not specifically measure posttraumatic stress or depressive reactions. Yule (2) reported results of cognitive-behavioral treatment among girls after the sinking of the cruise ship Jupiter. After 5-9 months, the group who received treatment had lower scores on the Impact of Event Scale and on a fear survey. These findings would have been more definitive had the baseline scores for subjects not given treatment been included in a treatment-by-time interaction analysis.The Psychiatric Outreach Program of the Armenian